Abstract

BUTTARO, Martín et al. Reconstrucción de calcar femoral con mallas metálicas, aloinjertos óseos impactados y tallos cementados en cirugía de revisión. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2012, vol.77, n.2, pp.96-103. ISSN 1852-7434.

Background: One of the essential requisites for the impaction grafting method is containment of the impac-ted cancellous bone within the medullary cavity. In patients with segmental bone loss, this procedure can be performed with metal mesh on the outside of the femur. Although the combination between metal meshes and impacted bone allografts is commonly used clinically, data in literature is lacking. Objective: To analyse the results in cases with proximal femoral bone defects reconstructed with a calcar metal mesh, impacted bone allografts, and a cemented stem in revision hip surgery. Methods: We prospectively followed 91 cases with proximal femoral bone defects reconstructed between 2002 and 2006 with a calcar metal mesh, impacted bone allografts, and a cemented stem. Patients' average age was 66 years (range, 32-88 years); there 64 females and 27 males. Femoral deficiencies were classified according to the Endoklinik: 50 cases presented a grade 3 defect, 38 cases presented a grade 4 defect and 2 cases a grade 1. We implanted 44 short conventional stems and 47 long stems. Results: Reconstruction survival was 98% after a minimum follow-up of 31 months and a maximum of 87 months. We observed one fracture of the metal mesh and femoral long stem that was reoperated and a traumatic asymptomatic fracture of the metal mesh that did not require surgery 1.5 years after this episode. Average stem subsidence was 3.6 mm. We observed 8 dislocations (9%), 7 infections (8%) and 2 periprosthetic fractures. Conclusions: Although the incidence of complications in these patients was high, this could be related to the complexity of the cases. Mesh failures were not observed except in the two cases presenting massive femoral bone loss and trauma. Patients with calcar femoral defects may be candidates for biological femoral reconstructions using metal mesh, impacted bone allografts and a cemented stem.

Keywords : Revisión hip surgery; Femoral bone loss; Metal meshes.

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